Current and future public health is characterized by the increase of chronic and degenerative diseases, corresponding to the worldwide ageing of the population. The increasing prevalence of these conditions together with the long incubation period of the chronic diseases and the continual technological innovations, offer new opportunities to develop strategies for early diagnosis.
Public Health has an important mandate to critically assess the promises and the pitfalls of disease screening strategies. This MOOC will help you understand important concepts for screening programs that will be explored through a series of examples that are the most relevant to public health today. We will conclude with expert interviews that explore future topics that will be important for screening.
By the end of this MOOC, students should have the competency needed to be involved in the scientific field of screening, and understand the public health perspective in screening programs.
This MOOC has been designed by the University of Geneva and the University of Lausanne.
This MOOC has been prepared under the auspices of the Ecole romande de santé publique (www.ersp.ch) by Prof. Fred Paccaud, MD, MSc, Head of the Institute of Social and Preventive Medicine in Lausanne (www.iumsp.ch), in collaboration with Professor Antoine Flahault, MD, PhD, head of the Institute of Global Health, Geneva (https://www.unige.ch/medecine/isg/en/) and Prof. Gillian Bartlett-Esquilant (McGill University, Quebec/ Institute of Social and Preventive Medicine, Lausanne).

Reviews

JG

very interesting. I learned a lot about diseases. Very informative course.

NA

Apr 30, 2020

Filled StarFilled StarFilled StarFilled StarFilled Star

I am very happy and proud of my achievements, I will continue to learn.

From the lesson

Introduction to Key Concepts in Screening

This module will provide a brief welcome by Dr. Fred Paccaud and Dr. Antoine Flahault. An overview of screening and an introduction on how the course is organized and evaluated will be provided by Dr. Gillian Bartlett-Esquilant. Dr. Idris Guessous, a Senior Lecturer in the Population Epidemiology Unit in the Department of Community Medicine, Primary Care and Emergency Medicine (Geneva), and in the Department of Ambulatory Care and Community Medicine (PMU Lausanne) & Division of Chronic Diseases at the Institute of Social and Preventive Medicine (Lausanne) will provide lectures on definitions of screening. Natural history of diseases and the characteristics of subclinical conditions allowing early diagnosis will be presented. A quiz on the key concepts for screening will complete this module.

Gillian Bartlett-Esquilant

Transcript

So, two different preventive strategy: high risk approach or population approach, and both can be used in screening which is secondary prevention. High risk approach is really targeting people at a higher risk of presenting with the disease. Yet, they are fewer or they are less frequent in the population. As you can see on the slide, again using the blood pressure example, one approach is really to look at the distribution of the blood pressure in the population, one of these figures, and to determine a cut-off saying this is too high. This patient or this participant or subject is too high a risk of presenting the disease, and I will really screen this population to identify these high risk individuals. As you can see it will be a small number or a smaller number of participant or subjects in the population. But you know that these people, they are not many maybe, but they are really at higher risk or relative risk of presenting a disease like stroke, heart attack or kidney damage. The other example is the population approach. Here, you do not define any specific cut-off. As you can see on the slide, you have again one slide which describe the normal distribution of the blood pressure in the population. Here, you are not identifying any cut-off or thresholds of blood pressure. You will assume that if you move all the distribution to the left, for example, the mean level of blood pressure in your population would decrease in general, on average you would have an impact in terms of public health. You may have a more little impact or effect, but they are a much increased number of subject that may change his or her blood pressure, and therefore you would have a benefit which might be greater than targeting the high-risk population or subjects. Both have advantages and limitations. There is one approach now that is really useful which is combining high risk and a population-based approach. For example, you could really, if we stay in the example of hypertension, you could use a high-risk approach by screening the population. You would recommend physicians to measure blood pressure in their patients once a year. You could identify people who are above certain cut-off, and you could also decide to reduce the amount of salt in diet, to make any promotion of physical activity, to try to decrease the consumption of salt, increase the physical activity, decrease your BMI in the population. All together should move the mean level of blood pressure to the left of your distribution and then you will have a mixed effect from high-risk population and the general population. This only works if you have a strong collaboration, strong interaction between the public health, and physicians, or people involved in clinical care.

Explore our Catalog

Join for free and get personalized recommendations, updates and offers.